Streamlining prior authorization to achieve the benefits of utilization management
Jonathan Murray SVP, Digital UM Solutions, eviCore healthcare
12/17/2018
Medical benefit management (aka utilization management) solutions such as those offered by eviCore healthcare are proven to reduce costs, protect patient safety and drive optimal outcomes. UM programs typically require that providers secure prior authorization in order to get reimbursed for procedures and tests. Prior authorization assures adherence to evidence-based guidelines and payer-specific policy.
Unfortunately, traditional prior authorization processes impose high costs and burden on providers. This can cause friction between plans and contracted providers, presenting barriers to achieving the benefits of UM.
That’s because securing prior authorization depends on time-consuming manual processes such as phone calls and faxes and use of many disconnected tools and data sources. For example, provider staff might use one source to confirm member eligibility, another to verify whether or not a PA is required, and yet another to figure out what entity is responsible for issuing the PA. Even online submission is complicated because it requires accessing multiple portals, even for a single health plan, because some clinical areas are handled by a delegated entity and some are managed internally.
To address this issue, eviCore now offers the eviCore intelliPath electronic prior authorization solution. intelliPath ePA makes it easier for providers to generate, submit, and track requests for pre-approval. That means health plans like yours get the benefits of prior authorization while keeping providers and members happy.
intelliPath works by integrating with the provider’s enterprise EHR (Allscripts, athenahealth, Cerner or Epic), pulling relevant information into the case form. This avoid the time and errors associated with manual case creation and moves the case quickly into the payer’s/eviCore’s request queue. Case status is updated dynamically, eliminating the need for constant phone calls and web portal visits to check on the status of a case. By streamlining provider processes, intelliPath reduces the administrative costs and burden that cause friction around the need for prior authorization.
For more information, please contact me at jmurray2@evicore.com or at 317.373.1024. You may also download the presentation from our recent Alliance Vendor Spotlight.